Supporting self‐management after traumatic brain injury: Codesign and evaluation of a new intervention across a trauma pathway

Abstract

Background Supported self‐management (SSM) is a recognized approach for people with long‐term conditions but, despite the prevalence of unmet needs, little is known about its role for people with traumatic brain injury (TBI). Objectives To codesign an SSM intervention with people with TBI and evaluate feasibility of implementation through multidisciplinary staff across a trauma pathway. Setting and participants People who had previously been admitted to a Major Trauma Centre following TBI and family members participated in a series of codesign activities. Staff attended SSM workshops and used the intervention with patients in acute and rehabilitation settings. Methods We used Normalization Process Theory constructs to guide and interpret implementation. Knowledge, beliefs and confidence of staff in SSM were assessed through pre‐ and post‐training questionnaires, and staff, patients' and families' experiences were explored through semi‐structured interviews. Qualitative data were analysed thematically, and clinical measures were mapped against a matched sample. Results Codesigned resources were created and used within an SSM approach for which 110 staff participated in training. Evaluation demonstrated significant differences in staff SSM confidence and skills, following training. Qualitative evaluation revealed adoption by staff, and patients' and families' experiences of using the resources. Challenges included reaching staff across complex pathways to achieve collective implementation. Conclusion This is the first project to demonstrate feasibility of SSM for people after TBI starting in an acute trauma setting. Through an open approach to codesign with a marginalized group, the SSM resources were valued by them and held meaning and relevance for staff.

Pilot trial of The Living Well Toolkit: qualitative analysis and implications for refinement and future implementation

“…However, we acknowledge that this response may ultimately be inadequate and the flexibility, although clearly an ideal and desirable feature to fit a wide range of situations [14], may be difficult to balance with the sense of being individualised enough for any one unique user or purpose [5]. The flexibility in application may also continue to be challenging for clinicians, who, in this phase, were responsible for introducing and supporting use of the client toolkit; a finding not dissimilar to other studies [30]. The collective action required to operationalise an intervention into practice may be simpler when it is tailored more specifically for a narrowly defined purpose or group of users.…”

“…Consequently we were surprised to see these two divergent responses to the toolkit package. It may be that these responses highlight differing degrees of critical reflection [13,[28][29][30]. Alternatively, the concept of collective action highlights the work that clinicians have to do to integrate interventions into practice [20], which may have been limited.…”

Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project

“…The barriers to integrating self-management support to enable patients and families more control over their care are challenging in a highly routinised, medical environments such as acute major trauma. However, the benefits of multidisciplinary team (MDT) training in acute settings are emerging9 12 13 and evaluations have shown that clinicians trained to support self-management are more satisfied with their practice 14…”

“…The Bridges SMP is an evidence-based educational intervention that has been tested and developed in different rehabilitation settings since 2008 13 17–20. Earlier work focused on implementation in community stroke settings but in 2013, Bridges SMP was successfully integrated into the working practices of a multidisciplinary acute stroke ward19 and in 2015 into a multidisciplinary traumatic brain injury pathway 13 21.…”

“…The Bridges SMP is an evidence-based educational intervention that has been tested and developed in different rehabilitation settings since 2008 13 17–20. Earlier work focused on implementation in community stroke settings but in 2013, Bridges SMP was successfully integrated into the working practices of a multidisciplinary acute stroke ward19 and in 2015 into a multidisciplinary traumatic brain injury pathway 13 21. Studies to date have shown that Bridges SMP is experienced positively by patients and families19 22 can improve patient involvement in their rehabilitation, foster greater feelings of control in patients22 and improve clinician’s confidence to support self-management 23.…”